Where Health Reform, Medical Innovation, and Physician Practices Meet - The Leading Voice for Medical Innovation on the Internet

Saturday, March 29, 2008

Hospitals and Doctors, future - The Future of Hospitals and Baby Boomer Physicians

This is not a good time to be a hospital CEO.

From the Bush Medicare budget request over the next five years comes this news.

• The largest amount of Medicare cuts, by far, will come from hospitals: $15 billion from an across-the-board reduction in the annual updates for inpatient care; $25 billion from special payments to hospitals serving large numbers of poor people; and $20 billion from capital payments for constructing hospital buildings and the purchase of equipment.

And from the mean streets come these pieces of news about baby boomer physicians.

• The urge for physicians to be employed by hospitals will surge. Younger and older baby boomer physicians want security, time off, regular hours, vacations, malpractice coverage, and relief from the risks of running a business. This makes hospital CEOs wary because they took a financial bath during the late 1990s when they acquired hospital practices. Still. doctors need intensivists, hospitalists, ER doctors, and even general surgeons – positions in which doctors can enjoy 40 hour work weeks. For hospitals, these doctors, often in short supply, do not come cheaply. It costs as much as $443,000 to recruit a cardiologist, $471, 000 an orthopedic surgeon, $263.000 an internist, and $246,000 for a family physician.

• At the same time, more physicians are seeking independence from hospitals. The shift to ambulatory care is in full swing, as doctors seek autonomy. Unfortunately, for the hospital CEO, many physicians seeking less dependency - orthopedic surgeons, cardiovascular specialists, proceduralists of every ilk – contribute the most to hospital bottom lines. The lure of being your own person of controlling your own destiny in terms of income and clinical practice is well nigh irresistible. This means hospitals must hire these specialists for internal coverage and external coverage.

• Conflicts over call coverage will haunt hospitals. Legally hospitals have to be open 24 hours a day and to accept all comers to the emergency rooms. This is tough when uninsured rolls are growing, and people tend to go to the ER rather than bother their doctor. Furthermore, specialists are reluctant to come in at all hours to treat patients they have never seen, who pose formidable malpractice risks, and who cannot afford to pay.

• The physician shortage is intensifying. The Council on Physician and Nurse Supply, an independent group of healthcare leaders based at the University of Pennsylvania, has called on the White House to convene a special conference to address an estimated 30% national shortage of physicians and nurses. The council estimates the U.S will be 150,000 to 200,000 short of physicians by 2020, and nursing schools must produce 30,000 more nurses a year to keep up with demand. This shortage places new economic demands for hospitals, who must pay more recruiting expenses or hire locum tenens physicians or traveling nurses to fill the gaps.

Small wonder hospital CEOs place physician relations and nurse shortages as number one and two on their agendas. The good news is that hospitals have been running record profits over the last five years and have a cushion to address these problems. The bad news for hospitals that no immediate solutions are in sight. They good news for doctors is that they are in greater demand and call the tune. The bad news for some, not all, is that they must become employees rather than independent practitioners.

9 comments:

RichardWhat do think the doctors really WANT? Are they eager and willing to enter into employment agreements with hospitals, or would that be a "last resort" measure taken by a physician who feels he or she is a victim of an increasingly unfriendly practice environment?I'd love to hear your thoughts. Thanks!Philippa Kennealy MD MPH CPCC PCCwww.entrepreneurialMD.com

RichardWhat do think the doctors really WANT? Are they eager and willing to enter into employment agreements with hospitals, or would that be a "last resort" measure taken by a physician who feels he or she is a victim of an increasingly unfriendly practice environment?I'd love to hear your thoughts. Thanks!Philippa Kennealy MD MPH CPCC PCChttp://www.entrepreneurialMD.com

Replica Omega Watches solve this dilemma for most of us by bringing within our reach the watch we have been dreaming about all along.Most of the replica watches are so well made that other than an expert no one would be in a position to determine which a real one is and which a replica is.

The Health Reform Maze

Buy the Book

Book Description: In this first book in a series of four, Richard L. Reece, MD. provides a unique view of the roll out, and run up, of the Affordable Care Act. Reece shows in this book the progress and facets of ObamaCare's marketers and messengers, as the day approached for the launch of health insurance exchanges - the single most public and problematic portion of the new law. This is a must read for anyone who wants to chronicle this attempt to organize more than one-sixth of the U.S. economy by adding layers of federal government control and regulations.

Reece has been writing about U.S. health care for more than 45 years. His knowledge and experience, added to his keen intellect and gift of subtle humor, make this book a valuable part of anyone's collection.